title: Does preoperative statin therapy improve outcomes in patients undergoing isolated cardiac valve surgery?
abstract: Preoperative statins have been associated with decreased mortality after coronary artery bypass grafting. Data are limited on whether these benefits extend to patients undergoing cardiac valve surgery. We examined whether preoperative statins decrease morbidity and mortality in patients undergoing isolated cardiac valve surgery. In a retrospective cohort analysis of consecutive patients who underwent surgical valve repair or replacement (excluding concomitant coronary artery bypass grafting, aortic root replacement, or ventricular assist device placement) at St. Luke's Episcopal Hospital, the primary outcome was 30-day mortality. Secondary outcomes included 30-day major adverse events (composite of early mortality, postoperative myocardial infarction, or stroke). Of 825 patients, 31% received preoperative statins (n = 255). Logistic regression analysis revealed that age >65 years (p = 0.02), history of congestive heart failure (p = 0.001), and total bypass time >80 minutes (p = 0.01) were independent predictors of increased 30-day mortality. Preoperative statin therapy was not associated with decreased 30-day mortality (odds ratio 0.89, 95% confidence interval 0.38 to 2.03), major adverse events (odds ratio 1.09, 95% confidence interval 0.61 to 1.96), postoperative myocardial infarction (p = 0.70), or stroke (p = 0.57). At a mean follow-up of 1.57 years, preoperative statin therapy was not associated with decreased mortality (p = 0.81). In the analysis using propensity score matching (354 propensity-matched patients, 177 in each group), preoperative statin was not associated with improved primary or secondary outcomes. In conclusion, preoperative statin therapy was not associated with a decrease in morbidity or mortality in patients undergoing isolated cardiac valve surgery.
authors.affiliation: Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
authors.forename: Vijay
authors.initials: V
authors.lastname: Nambi
authors.forename: Vei-Vei
authors.initials: VV
authors.lastname: Lee
authors.forename: MacArthur
authors.initials: M
authors.lastname: Elayda
authors.forename: Ross M
authors.initials: RM
authors.lastname: Reul
authors.forename: James M
authors.initials: JM
authors.lastname: Wilson
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
mesh_terms: D006348:Cardiac Surgical Procedures / Q000401:mortality*; D005260:Female; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors